Organization Active NPI

Rowansom Dept of Family Practice

  • Family Medicine Physician
  • Stratford, NJ
National Provider Identifier
1790765055
Registry record updated May 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
ROWANSOM DEPT OF FAMILY PRACTICE
Practice address
42 East Laurel Road
Udp, Suite 2100
Stratford, NJ 08084
Phone
(856) 566-7020
Fax
(856) 566-6188
NPI assigned
Jan 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael Rieker
Title
Interim Chief Financial Officier
Phone
(856) 770-5729

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

42 East Laurel Road
Udp, Suite 2100
Stratford, NJ 08084

Mailing address

PO Box 635
Bellmawr, NJ 08099-0635
Phone (856) 566-6706

Other identifiers 2

IdentifierTypeStateIssuer
3215709MedicaidNJ
CA1750OtherNJRR MEDICARE

Other names 1

  • UMDNJ-SOM Dept of Family Practice Former legal business name

National Provider Directory

National Provider Directory

Locations

854 S White Horse Pike
Unit 4
Hammonton, NJ 08037
Phone (609) 704-0185

777 S White Horse Pike
Ste D1
Hammonton, NJ 08037
Phone (609) 561-0033

16 W Main St
Marlton, NJ 08053
Phone (609) 770-5736

2001 Lincoln Dr W
Ste F
Marlton, NJ 08053
Phone (609) 922-0082

1025 Briggs Rd
Ste 144
Mount Laurel, NJ 08054
Phone (856) 642-0255

416 Sicklerville Rd
Ste 14
Sicklerville, NJ 08081
Phone (856) 728-8900

42 E Laurel Rd
#2100
Stratford, NJ 08084
Phone (856) 566-7020

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368576000000",
    "number": "1790765055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635",
            "city": "BELLMAWR",
            "state": "NJ",
            "postal_code": "080990635",
            "telephone_number": "856-566-6706",
            "fax_number": "856-566-2797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 EAST LAUREL ROAD",
            "address_2": "UDP, SUITE 2100",
            "city": "STRATFORD",
            "state": "NJ",
            "postal_code": "08084",
            "telephone_number": "856-566-7020",
            "fax_number": "856-566-6188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROWANSOM DEPT OF FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-20",
        "last_updated": "2013-05-15",
        "status": "A",
        "authorized_official_last_name": "RIEKER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "INTERIM CHIEF FINANCIAL OFFICIER",
        "authorized_official_telephone_number": "856-770-5729"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3215709",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CA1750",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UMDNJ-SOM Dept of Family Practice",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Stratford, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.